Provider Demographics
NPI:1417000662
Name:O BRIEN, IENNATICA LYNNE (OTRL)
Entity Type:Individual
Prefix:MS
First Name:IENNATICA
Middle Name:LYNNE
Last Name:O BRIEN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5422 HAVEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1250
Mailing Address - Country:US
Mailing Address - Phone:281-913-2009
Mailing Address - Fax:
Practice Address - Street 1:6109 MAPLE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-7449
Practice Address - Country:US
Practice Address - Phone:713-668-6690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109489225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist